Membership Form for the System Dynamics Society

Please print this form and clearly write in the requested information. Please mail or fax to us at the address printed below.

Member #:

(if renewing)

 

Name:

 

 

Position/Job Title:

 

 

Organization:

 

 

E-mail:

 

 

Phone:

 

 

 

 

 

Optional information for the Online Directory:

 

Alternate E-mail:

 

 

Fax Number:

 

 

Mobile Phone:

 

 

Home Phone:

 

 

Website: http://

 

 

Postal address for the Directory and Society correspondence:

Delivery address for the System Dynamics Review:

 

 

Work

 

 

Home

 

 

Same as Postal Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Online Directory Permission (we will send your password by email):

 

Yes

I would like to be listed in the members-only online directory.

 

No

I do not wish to appear in the directory.

Mailings from John Wiley & Sons:

 

Yes

I would like to receive additional mailings from John Wiley & Sons publishers of the System Dynamics Review on related books and journals. Mailings may be sent up to twice per year.

 

No

I do not wish to receive additional mailings from John Wiley & Sons.

2005 MEMBERSHIP:

 

 

Regular Member ($90.00)

 

 Please indicate your membership category for the calendar year 2005:

 

 

Full-time Student/Subsidized Member* ($45.00) *A subsidized membership is for an individual with a gross family income of less than US$20,000.

 

PAYMENT DETAILS:

 

Please send me an invoice.  Membership will be entered when payment is received.

 

Check enclosed (in US dollars, drawn on a US bank, payable to System Dynamics Society)

 

I wish to pay by wire transfer.  Please send me the Society’s bank details.

 

Credit card:

Visa

 

 

MasterCard

 

 

American Express

 

 

Diners Club

 

 

Card number:

 

Billing address of card, if different than address above:

Expiration date:

 

 

Signature:

 

 

Please note: Society memberships are for individuals. Institutional or company subscriptions to the System Dynamics Review are available directly from the publisher John Wiley & Sons; contact Sarah Stevens at sasteven@wiley.co.uk

Other information for the Online Directory:

Chapter and/or Special Interest Group (SIG) Affiliation (choose up to three):1

 

Australasia

 

 

Work Category  (choose up to two)

 

Brazil

 

 

Academic

 

China

 

 

Health Care

 

Economic Dynamics

 

 

Consulting/Training/Software

 

Egypt

 

 

Corporate

 

Hellenic

 

 

K-12 Education

 

Student

 

 

Government/Public Policy

 

Italy

 

 

Student

 

Latin America

 

 

Military

 

Japan

 

 

Retired

 

Korea

 

 

Other

 

Switzerland

 

 

 

 

UK

 

 
Beer Game Facilitator2

 

Environmental Dynamics SIG

 

 

 

 

Health Policy SIG

 

 

 

 

Higher Education SIG

 

 

 

 

Security SIG

 

 

 

1 In addition to listing your Chapter/SIG affiliation(s) in the Online Directory, your name will be sent to the Chapter/SIG representative(s) to inform them of your interest or confirm your affiliation. Some Chapters charge membership fees.

2 We refer names to those who contact the Society looking for beer game facilitators.

The Online Directory will also allow you to upload your photograph and add keywords that help define your interests.

Please return with your payment to:

Roberta L. Spencer, Executive Director

System Dynamics Society

Milne 300 – Rockefeller College

University at Albany, Albany NY 12222 USA

E-mail:   system.dynamics@albany.edu

Fax:   +1 (518) 442-3398

Please contact the Society office if you have any questions. +1 (518) 442-3865

Thanks!

Dear Member:

The System Dynamics Society has made a commitment to increasing the diversity of our membership. As part of that commitment, we would like to learn more about the Society’s demographics.

Please consider taking a few minutes to complete this confidential survey and return it along with your membership form. The information will be used to help monitor membership trends. The survey is completely voluntary. Answering some, all, or none of the questions will have no effect on your membership status. This information will not be included in the membership directory. All reports will be limited to aggregate summaries. This survey is totally independent from the membership renewal information.

Please contact Peter Hovmand at <phovmand@wustl.edu> if you have any questions about this survey.

Thank you,

The System Dynamics Society

Diversity Subcommittee

What is your gender? (PLEASE CHECK THE BOX OF YOUR RESPONSE)

Female

 

 

Male

 

What is your age? (PLEASE CHECK THE BOX OF YOUR RESPONSE)

19 or under

 

 

20 to 24

 

25 to 29

 

 

30 to 34

 

35 to 39

 

 

40 to 44

 

45 to 49

 

 

50 to 54

 

55 to 59

 

 

60 to 64

 

65 to 69

 

 

70 to 74

 

75 or older

 

 

 

 

Are you currently a student? (PLEASE CHECK THE BOX OF YOUR RESPONSE)

Yes

 

 

No

 

9            If yes, what type of educational program? (PLEASE CHECK THE BOX OF YOUR RESPONSE)

K-12

 

 

Undergraduate

 

 

Masters program

 

 

Doctoral program

 

 

Other (DESCRIBE):